Unstable angina / non ST elevation myocardial infarction diabetic patients
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Overview of Diabetic Patients with UA / NSTEMI
Pathology Findings
Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. © PEIR, University of Alabama at Birmingham, Department of Pathology
 Heart, acute myocardial infarction, 6 days old, in a patient with diabetes mellitus and hypertension |
 Heart, acute myocardial infarction, 6 days old, in a patient with diabetes mellitus and hypertension |
 Heart, acute myocardial infarction, 6 days old, in a patient with diabetes mellitus and hypertension |
 Heart, acute myocardial infarction, 6 days old, in a patient with diabetes mellitus and hypertension |
 Heart, acute myocardial infarction, 6 days old, in a patient with diabetes mellitus and hypertension |
 Heart, acute myocardial infarction, 6 days old, in a patient with diabetes mellitus and hypertension |
 Heart, acute myocardial infarction, 6 days old, in a patient with diabetes mellitus and hypertension |
 Heart, acute myocardial infarction, 6 days old, in a patient with diabetes mellitus and hypertension |
ACC / AHA Guidelines (DO NOT EDIT) [1]
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Class I1. Medical treatment in the acute phase of UA / NSTEMI and decisions on whether to perform stress testing, angiography, and revascularization should be similar in patients with and without diabetes mellitus. (Level of Evidence: A) 2. In all patients with diabetes mellitus and UA / NSTEMI, attention should be directed toward aggressive glycemic management in accordance with current standards of diabetes care endorsed by the American Diabetes Association and the American College of Endocrinology. Goals of therapy should include a pre-prandial glucose target of <110 mg/dL and a maximum daily target of <180 mg/dL. The post discharge goal of therapy should be HbA1C <7%, which should be addressed by primary care and cardiac caregivers at every visit. (Level of Evidence: B) 3. An intravenous platelet GP IIb/IIIa inhibitor should be administered for patients with diabetes mellitus as recommended for all UA / NSTEMI patients. (Level of Evidence: A)
Class IIa1. For patients with UA / NSTEMI and multi vessel disease, CABG with use of the internal mammary arteries can be beneficial over PCI in patients being treated for diabetes mellitus. (Level of Evidence: B) 2. Percutaneous coronary intervention is reasonable for UA / NSTEMI patients with diabetes mellitus with single-vessel disease and inducible ischemia. (Level of Evidence: B) 3. In patients with UA / NSTEMI and diabetes mellitus, it is reasonable to administer aggressive insulin therapy to achieve a glucose <150 mg/dL during the first 3 hospital (intensive care unit) days and between 80 and 110 mg/dL thereafter whenever possible. (Level of Evidence: B) | ” |
See Also
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [1]
References
- ↑ 1.0 1.1 Anderson JL, Adams CD, Antman EM, et al (August 2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". JACC 50 (7): e1–e157. PMID 17692738.
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
